Provider Demographics
NPI:1235574195
Name:SPRINKLE, SHANNA R (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:R
Last Name:SPRINKLE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 GREENWAY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203
Mailing Address - Country:US
Mailing Address - Phone:405-226-6883
Mailing Address - Fax:
Practice Address - Street 1:102 PROFESSIONAL PARK STE C
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2554
Practice Address - Country:US
Practice Address - Phone:919-603-0368
Practice Address - Fax:919-690-0842
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02997208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2023-02997OtherNC STATE MEDICAL LICENSE
NJ25MA11586200OtherNJ STATE MEDICAL LICENSE